Vascular remodeling promotes the development and progression of cardiovascular disease, and is crucial for cardiovascular events and prognosis. Intervention of pathological vascular remodeling is an important strategy for preventing and treating complications of cardiovascular disease and improving prognosis. Vascular adventitia has been regarded as a supportive and protective tissue for blood vessels for a long time, but now it is believed that the adventitia is the signal analysis and processing center of the blood vessels. It directly modulates the structure and function of blood vessels, and plays a key role in vascular remodeling, especially in the progression and prognosis of cardiovascular diseases. Fibroblasts are the main cellular component of the adventitia, and play a particularly prominent role in the occurrence and development of vascular remodeling. This review is focused to show the role and mechanism of the adventitia fibroblasts in vascular remodeling, especially in hypertension, atherosclerosis, aortic aneurysm and aortic dissection.